A physician makes a diagnosis by first taking a medical history, interviewing the patient, then physically examining the patient and then when necessary getting x-rays or other diagnostic tests. By far the most important parts of this process are the first two steps, interviewing the patient and examining the patient.
Skilled physicians rely on their training and experience to make an accurate diagnosis. What follows here is an explanation of the process a qualified physician goes through and is not intended as a cookbook recipe for self diagnosis.
Identifying a patients chief complaint is the first step to diagnosing a hernia. Patient's symptoms may vary considerably but an experienced surgeon is familiar with 99.99% of all symptoms that can be produced by a hernia.
A bulge somewhere in the abdomen is the most common and significant symptom of a hernia. Hernia bulges are typically aggravated by strenuous physical activity. Bulges may be as big as a cantaloupe or as small as a pea. Bulges may come and go with no apparent rhyme or reason. Not all patients with a hernia experience a bulge but the absence of a bulge puts the diagnosis of a hernia into serious doubt.
Pain or other discomfort is another common complaint for hernia patients. The discomfort may be localized to the hernia or may be anywhere in the belly. When bowel is pinched the bowel pain is poorly localized by our nervous systems. It is like the "brain freeze" you get when you eat ice cream. Your esophagus is sending pain signals but your brain does not know where it is coming from and thinks it is coming from your forehead.
Other factors related to the symptom are also important such as location, duration, what makes it better, what makes it worse, and severity.
There are other symptoms which a hernia can cause but they should be attributed to a hernia with caution.
The patients medical history is examined to identify risk factors that would explain why the patient developed the hernia. Hernias are very common and most patients do not have a specific reason why they developed a hernia. Previous abdominal surgery will weaken the abdominal wall and it is an important risk for hernia occurrence. Obesity, strenuous physical activity, inheritance and cigarette smoking are other risk factors related to hernias.
Examination of the patients medical history is important for identifying illness that may make surgery unsafe. High blood pressure, asthma and diabetes are examples of common medical conditions which should be treated before a patient is taken to surgery.
The doctor will ask the patient about all medications and supplements that they take. Many currently popular supplements that are taken for heart health are also blood thinners and will increase the risks of bleeding complications. These include aspirin, vitamin E and omega fatty acid supplements such as fish oil and flax seed oil.
The doctor needs to know the patients age, sex height and weight because these are factors that can affect the safety of the surgery or explain why the patient got the hernia.
Mastery of the art of physical diagnosis is what sets clinicians above all other medical practitioners. By visual inspection and manual palpation a doctor can assess a hernia nearly instantly and with accuracy that far exceeds any diagnostic test. Experience doctors have seen and palpated thousands of hernias. They are also very familiar with normal human anatomy and the pathophysiology of hernias. An examination by a qualified physician is the standard for diagnosing a hernia. General surgeons are the specialists who are the most qualified.
CT scan, MRI and Ultrasound are all very poor tests for detecting hernias. Some centers are doing dynamic imaging studies which are a little more sensitive at detecting hernias. The problem with all of these studies is the false negative rate is 20% or greater. If the hernia is not bulging at the time of the imaging test it will not be detected by the test. Another experiment imaging study is contrast peritoneography also known as herniography.
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"Milan—Chronic groin pain after hernia surgery is now considered the most important issue facing inguinal hernia surgeons and their patients. Yet, there is still much uncertainty surrounding what causes the pain and how to prevent it." - Victoria Stern, General Surgery News